Variceal bleeding in cirrhosis is one of the most challenging problems in gastroenterology. Bleeding from gastro-oesophageal varices is a main cause of early death (approximately 30%-50% at the first bleeding) in cirrhosis. The aim of our therapy is to locate the place of bleeding, control active bleeding and prevent rebleeding, but it is difficult sometimes. A number of treatment strategies, such as somatostain analogs, vasopressin, endoscopic therapy, transjugular intrahepatic portasystemic shunt (TIPS) have evolved over time, but which is better? New evidence of therapy for variceal haemorrhage will be introduced in Cirrhosis that includes: 1.Somatostatin, vasopressin, ligation, schlerotherapy and balloon tamponade for acute variceal bleeding; 2.β-blockers, ligation, schlerotherapy and shunt surgery for prophylaxis of primary variceal bleeding; 3.β-blockers, ligation, schlerotherapy, shunt surgery and TIPS for prophylaxis of variceal rebleeding; 4. Antibiotic prophylaxis for cirrhosis with gastrointestinal bleeding.
Objective To formulate the treatment of Barrett esophagus and provide evidence-based solutions for doctors and patients. Methods We attempted to obtain evidence for treating Barrett esophagus by searching MEDLINE (1978 to 2005), CBMdisc (1978 to 2005) and The Cochrane Library (Issue 4, 2005). The quality of the retrieved evidence was evaluated. Results The therapies for Barrett esophagus include dietary intervention, change of life style, drug therapy, endoscopic therapy and surgery. We should choose different therapies according to the specific conditions of patients. Conclusions Endoscopic therapy has been developed a lot in recent years. The combination of two or more therapies may produce better effects.
目的:探討幽門螺桿菌(Hp)感染與各種常見上消化道疾病的關系。 方法:回顧性地分析了2008年于我院采用快速尿素酶試驗(RUT)檢測Hp的6636例門診及住院患者Hp感染情況,及與性別、年齡、病種的關系。結果:6636例患者中,Hp陽性3248例,檢出率為48.9%;其中男性4391例,檢出率為49.97%,女性2 245例,檢出率為46.9%,男性略高于女性,差異有統計學意義(Plt;0.05);20～29歲和30～39歲這兩個年齡段Hp檢出率最高,分別為58.4%和54.6%,lt;20歲Hp檢出率最低(38.8%),各組間差異有統計學意義(Plt;0.01);各種常見的上消化道疾病,復合性潰瘍和上消化道惡性腫瘤Hp檢出率最高,分別為86.2%和84.1%,其次是幽門管潰瘍和十二指腸潰瘍,檢出率分別為54.2%和51.9%,慢性胃炎、殘胃炎、胃潰瘍和食管靜脈曲張Hp檢出率分別為46.9%、40.0%、36.6%和34.2%,各組間的差異有顯著的統計學意義(Plt;0.005)。 結論:本組資料Hp總檢出率為48.9%,男性略高于女性,慢性胃炎、消化性潰瘍和上消化道惡性腫瘤與Hp感染密切相關,尤以復合性潰瘍和上消化道惡性腫瘤更為顯著。
Objective To provide evidence of the role of helicobacter pylori eradication in the treatment of functional dyspepsia. Methods We searched VIP, CBMdisc, MEDLINE and The Cochrane Library for systematic reviews, meta-analysis, randomized controlled trials and clinical guidelines involving helicobacter pylori and functional dyspepsia, so as to provide the best evidence for clinical practice. Results We included two systematic reviews, one meta-analysis and eleven randomized controlled trials. The evidence identified showed that helicobacter pylori infection was more prevalent in functional dyspepsia than in asymptomatic patients, but the effect of H pylori infection in the pathogenesis of functional dyspepsia remained controversial. H pylori eradication therapy had a relatively weak effect in H pylori positive functional dyspepsia. An economic model suggested that this modest benefit may still be cost-effective, but more studies are needed to assess this. Conclusion According to the current evidence, it can be concluded that helicobacter pylori eradication for the treatment of functional dyspepsia should be individualized.
目的 針對近期收治的1例常規治療療效不理想的潰瘍性結腸炎患者,我們進行了證據檢索和評價,以期找到更有效的治療方法.方法 計算機檢索MEDLINE(1978～2004)、CBMdisc(1978～2004)及Cochrane圖書館(2004年第3期),查找 5-氨基水楊酸(5-ASA)灌腸液治療潰瘍性結腸炎及與病情緩解有關的系統評價、臨床隨機對照試驗等,并對所獲證據進行評價.結果 高質量的臨床證據表明,5-ASA灌腸液治療潰瘍性結腸炎及幫助病情緩解均優于口服5-ASA及柳氮磺胺嘧啶局部灌腸治療.據此臨床證據,結合醫生經驗及病人意愿,對該例患者實施5-ASA 1g+生理鹽水100 ml qd,睡前保留灌腸治療.1周后,患者臨床癥狀明顯緩解,腹瀉基本停止,每天解黃色黏液便1～2次.腸鏡復查,炎癥較前明顯減輕.出院后繼續用上述方案維持治療,每周2次.門診隨訪1年,患者未再復發,也無明顯副作用發生.結論 5-ASA灌腸液是控制潰瘍性結腸炎活動期間病情及幫助緩解、減少復發的有效藥物.
Objective To determine the effectiveness and safety of pneumatic balloon dilatation in patients with achalasia. Methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL, issue 1, 2007), MEDLINE or PUBMED (1978-2007), Embase (1978-2007), OVID Database (1978-2007), Chinese Biological Medicine Database (CBMDisc, 1978-2007), CNKI (1979-2007), Chinese VIP Database (1989-2007) and Wanfang Database (1978-2007). We also checked the reference lists of retrieved articles and relevant proceedings. We used the methods recommended by The Cochrane Collaboration to conduct this systematic review. Results Twenty four trials involving 1045 patients were included. Meta-analyses showed that the short-term total effective rate was much higher with pneumatic dilatation than intrasphincteric botulinum toxin injection (P=0.0007). The long-term total effective rate was higher with pneumatic dilatation compared to intrasphincteric botulinum toxin injection (P=0.005). Intrasphincteric botulinum toxin injection was superior to pneumatic dilatation in terms of clinical relapse rate (Plt;0.0001). Our analyses of complications and adverse effects found that pneumatic dilatation was superior to intrasphincteric botulinum toxin injection (P=0.0008), and endoscopic sphincterotomy was superior to balloon dilatation (P=0.0006). Conclusions The limited current evidence shows that: pneumatic dilatation is safe and effective for the short- or long-term treatment of achalasia.
Objective To assess the efficacy and safety of histamine H2 receptor antagonist (H2RA) for the prevention of stress ulcer bleeding (SUB) in critically ill patients. Methods Trials were identified by searching Cochrane Controlled Trials (Issue 4, 2006), MEDLINE (1980 to October 2006),EMbase (1984 to October 2006) and the Chinese Biological Medicine Database (1978 to October), Chinese VIP Database (1989 to October 2006) and Chinese EBM Database. We also handsearched the proceedings of relevant conferences, 5 kinds of important Chinese journals and the references of all included trials. Two reviewers assessed the quality of studies and extracteddata independently. Disagreement was resolved by discussion . The primary outcomes included were incidence of SUB, incidence of nosocomial pneumonia (NP), mortality and adverse events. Secondary outcomes were gastric pH, length of hospital stayand length of ICU stay. RevMan4.2.7 software was used for meta-analyses. Results Sixteen trials involving 2 014 patients were included. Most of the trials were of poor quality. Meta-analyses showed that H2RA significantly less SUB comparedwith patients in the placebo or non-prophylaxis group (RR 0.39, 95%CI 0.28 to 0.56; Plt;0.000 01, NNT=6), but but there was no significant difference in the incidence of clinically important bleeding (RR 0.51 , 95%CI 0.17 to 1.53; P=0.11). No significant difference was observed in the incidence of NP(RR 1.02, 95%CI 0.55 to 1.89,P=0.95). H2RA significantly decreased mortality in comparison with placebo or non-prophylaxis (RR 0.68, 95%CI 0.52 to 0.90; P=0.007, NNT=18). H2RA had a good safety profile. We did not perform meta-analysis for gastric pH due to the methodological limitations. Conclusion H2RA may significantly reduce the incidence of SUB and mortality, but cannot reduce the incidence of clinically important bleeding. Due to the poor quality of included studies, the conclusion should be interpreted cautiously. More randomized controlled trials with sufficient sample size, uniform standards, higher quality and scientifically sound methodology should be performed.
Objectives To assess the effectiveness and safety of additional bedtime H2-receptor antagonists (H2RAs) in suppressing nocturnal gastric acid breakthrough (NAB). Methods We identified eligible trials by searching The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMbase and CINAHL. We handsearched the data from the proceedings of correlated conferences, eight kinds of important Chinese journals and references of all included trials. All randomized controlled trials evaluating H2RAs for the control of NAB were eligible for inclusion. The systematic review was conducted using methods recommended by The Cochrane Collaboration. Results Only two randomized crossover studies including 32 participants met the inclusion criteria. Because the design, dosage and duration of the treatment were different between the studies, it was impossible to conduct Meta-analysis. There was no consistent conclusion between the two included studies in evaluating H2RAs for the control of NAB. Conclusion We can not conclude any implications for practice at this stage. Appropriately designed large-scale randomized controlled trials with long-term follow-up are needed to decide the effects of additional bedtime H2RAs in suppressing NAB.